血浆置换联合去甲肾上腺素治疗重型肝炎Ⅰ型肝肾综合征临床疗效分析  

Clinical curative effects of plasmapheresis combined with noradrenalin on patients with severe hepatitis complicated with type Ⅰ hepatorenal syndrome

作　　者：唐文[1] 蒋明德[1] 徐辉[1] 秦建平[1] 沈才飞[1] 

机构地区：[1]成都军区总医院消化内科,成都610083

出　　处：《西南国防医药》2011年第11期1192-1194,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的观察血浆置换联合去甲肾上腺素治疗重型肝炎Ⅰ型肝肾综合征患者的疗效。方法回顾性分析我院2008年1月～2010年12月收治重型肝炎Ⅰ型肝肾综合征27例住院患者的临床资料,根据治疗方法不同,分为对照组12例和观察组15例。分析重型肝炎Ⅰ型肝肾综合征患者的病因、肝肾功能、MELD评分、尿量以及住院病死率。结果该病主要发生于肝功能衰竭患者,易出现腹水、自发性腹膜炎、肝性脑病以及消化道出血等并发症。对照组治疗前后各指标无显著差异;观察组在治疗后总胆红素、肌酐以及MELD评分降低,尿量增加,与治疗前比较差异有统计学意义(P<0.05);两组治疗后总胆红素、肌酐、MELD评分以及尿量比较有显著差异(P<0.05);两组住院病死率差异无统计学意义(P>0.05),但在MELD评分<30分患者中,观察组住院病死率比对照组低(25.0%vs.85.7%,P<0.05)。结论血浆置换联合去甲肾上腺素治疗重型肝炎合并Ⅰ型肝肾综合征患者,有利于患者肝肾功能恢复,有一定的治疗作用。Objective To observe the curative effects of plasmapheresis combined with noradrenalin on patients with severe hepatitis complicated with type I hepatorenal syndrome. Methods A retrospective analysis was made among the 27 patients with severe hepatitis and type I hepatorenal syndrome hospitalized between January 2008 and December 2010. They were divided into control group（ 12 cases）and observation group（ 15 cases）according to different treatment they received. The etiological factors,hepatic and renal functions, MELD scores, urine volume and case fatality of these patients were analyzed. Results This disease mainly occurred in patients with／liver function failure and it was prone to have complications such as ascites, spontaneous peritonitis, hepatic encephalopathy and alimentary tract hemorrhage. All indexes in the control group showed no differences before and after the treatment. However, in the observation group, the total bilirubin, the creatinine and the MELD scores decreased while the urinary volume increased after the treatment compared with those before the treatment （P 〈 0.05 ）. And after the treatment, there were significant differences in total bilirubin, the creatinine, the MELD and the urinary volume between the both groups （P 〈 0.05 ）. The difference of the case fatality between the two groups was not statistically significant（ P 〉0.05）. In those patients whose MELD scores were lower than 30 ,the case fatality in the observation group was lower than that in the control group（25.0% vs. 85.7% ,P 〈 0.05 ）. Conclusion Plasmapheresis combined with noradrenalin in the treatment of patients ~th severe hepatitis and type I hepatoreual syndrome is helpful to the recovery of the patients＇ hepatic and renal functions and has certain curative effects.

关 键 词：重型肝炎 肝肾综合征 血浆置换 去甲肾上腺素 

分 类 号：R512.6[医药卫生—内科学]